Provider Demographics
NPI:1053492850
Name:OPTICAL EXPRESSIONS, INC.
Entity Type:Organization
Organization Name:OPTICAL EXPRESSIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-748-3536
Mailing Address - Street 1:2000 MEMORIAL DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ST JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-8321
Mailing Address - Country:US
Mailing Address - Phone:802-748-3536
Mailing Address - Fax:802-748-4838
Practice Address - Street 1:2000 MEMORIAL DR
Practice Address - Street 2:SUITE 6
Practice Address - City:ST JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-8321
Practice Address - Country:US
Practice Address - Phone:802-748-3536
Practice Address - Fax:802-748-4838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1309010001Medicare NSC